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In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic
Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency […] The post SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke first appeared on The Skeptics Guid
Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. We see all different flavors of upper extremity injuries. Yes, we’re talking about your clavicular , proximal humeral, supracondylar, lateral condylar , scaphoid and metacarpal fractures.
David Didlake @DidlakeDW EMS personnel responded to the residence of an 81 y/o Male with syncope. His spouse had called 911 after she heard a loud “thud” in the adjacent room. He was found altered, hypotensive, and with a large hematoma to the left periorbital region. No 12 Lead ECG was captured, but telemetry did reveal the following: The spouse offers a pertinent medical history to include HTN and HLD, and furthermore states that he hasn’t previously complained of any chest discomfort, or shor
We discuss the role of point-of-care ultrasound in evaluating the patient with kidney injury and assessing volume status, with Abhilash Koratala (@nephroP), nephrologist, Director of Clinical Imaging for Nephrology at the Medical College of Wisconsin, and champion of nephrology-focused ultrasound. Find us on Patreon here! Buy your merch here! Takeaway lessons References Episode 4 with … Continue reading "Episode 73: POCUS for nephrology, with Abhilash Koratala" We discuss the role of point-of-ca
In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.
Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care. February 2024. Date: April 25, 2024 Guest Skeptic: Missy Carter is a PA working in an ICU in the Tacoma area and an adjunct faculty member with the Tacoma Community College paramedic program.
Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care. February 2024. Date: April 25, 2024 Guest Skeptic: Missy Carter is a PA working in an ICU in the Tacoma area and an adjunct faculty member with the Tacoma Community College paramedic program.
We identify the presence of kidney stones using ultrasound with a pretest suspicion of kidney stones then identifying the presence or absence of hydronephrosis.
A 23-year-old female with no known past medical history presented with a rash concentrated on her legs, with a few areas on her arms and chest. The rash began the day before presentation when she became overheated while wearing sweatpants in 104°F weather. The rash was mildly pruritic but not painful. She denied any prior reaction to her sweatpants that she has had for several months.
Give your patients a break. Nobody is a perfect diagnostician. Not even the best trained physician can determine, with 100% accuracy, which patients have serious pathology. Even with advanced testing, we aren’t close to perfect. However, if you listen to the subtext of breakroom complaints, it seems like we expect patients to be better diagnosticians […] The post Are you a perfect diagnostician?
Patients living with functional neurologic disorders (FND) have been deeply stigmatized by the medical system. In a patient survey by FND Hope (an international organization for the research and advocacy around FND) 82% of patient respondents felt they had been treated poorly due to stigma relating to their FND diagnosis, primarily by emergency physicians [1] […] The post Functional Neurologic Disorders appeared first on EMOttawa Blog.
In this month's EM Quick Hits podcast: Justin Morgenstern on the first RCT of high dose nitroglycerin in SCAPE, Andrew Neill on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) indications and evidence, Brit Long on indications for CT in suspected diverticulitis, Tahara Bhate on Central Retinal Artery Occlusion (CRAO) and diagnostic error, Matthew McArthur on penicillin allergy labels, myths and penicillin challenges, and Susan Lu on how ED physician personality influences patie
Reference: Ramesh S, Ayyan SM, Rath DP, Sadanandan DM. Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. AEM April 2024 Date: April 19, 2024 Guest Skeptic: Dr. Suchismita Datta. She is an Assistant Professor and Director of […] The post SGEM#437: Don’t Be Fooled by the Meds I Got, I Still Need an ESP Block – For My Rib Fractures first appeared o
An elderly man collapsed. There was no bystander CPR. Medics found him in ventricular fibrillation. He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD. He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED.
Traditionally large-bore tube thoracostomy has been the standard of care for treating many acute intrathoracic pathologies [1]. However, the advent of less invasive small-bore chest tubes, also known as pigtail catheters, has gradually led to a paradigm shift. Pigtails provide a less invasive and often better tolerated alternative to traditional chest tubes and allow for adequate treatment of pneumothoraces and uncomplicated pleural effusions [1-5].
As mentioned in my most recent review, publication bias has been a major concern when trying to decide whether to prescribe paxlovid. Pfizer rushed to publish their positive study (EPIC-HR), but refused to release the results of a second simultaneous study (EPIC-SR) that was stopped (due to futility) at the exact same time. With the […] The post EPIC-SR: The negative paxlovid data Pfizer has been sitting on appeared first on First10EM.
This content is for AAA members only. Please either Log In or Join! The post FTC Publishes Final Rule Banning Employee Non-Compete Agreements appeared first on American Ambulance Association.
We review Acute Respiratory Distress Syndrome Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pulmonary Show Notes Definition of ARDS: Non-cardiogenic pulmonary edema characterized by acute respiratory failure. Berlin criteria for diagnosis include acute onset within 7 days, bilateral pulmonary infiltrates on imaging, not fully explained by cardiac failure or fluid overload, and impaired oxygenation with PaO2/FiO2 ratio <300 mmHg, even wi
Quiz The PM Cardio Queen of Hearts AI model for ECG interpretation from Powerful Medical is still in its early days. Do you think you can outperform the toddler version of the AI model? Version 2.0 will soon be available with four times the training data. The QoH groups ECGs into OMI and NOT OMI. Each category is subdivided into three levels of confidence.
In this episode, we discuss a recent paper on false electrical capture and pre-hospital transcutaneous pacing by paramedics. The guests, Tom Boutilet, Josh Kimbrell, and Judah Kreinbrook, discuss their research findings and the implications for paramedics. They conducted a retrospective study and found that paramedics often mistakenly believe they have electrical capture when they do not.
We explore critical care transport medicine from both a clinical and career perspective, including helicopters (HEMS), fixed wing jet, and ground ambulance transports, with Jace Mullen, flight paramedic and airway educator out of Denver. Find us on Patreon here! Buy your merch here! We explore critical care transport medicine from both a clinical and career perspective, including helicopters (HEMS), fixed wing jet, and ground ambulance transports, with Jace Mullen, flight paramedic and airway ed
This content is for AAA members only. Please either Log In or Join! The post U.S. DOL Issues Final Rule to Increasing the FLSA Overtime Exemption Salary Levels appeared first on American Ambulance Association.
On February 5, the Occupational Safety and Health Administration (OSHA) published a Notice of Proposed Rulemaking (NPRM) to modernize the agency’s “Fire Brigades” standard with a proposed new “Emergency Response Standard.” This NPRM’s publication triggered the beginning of a public comment period that was initially scheduled to conclude on May 6. Thanks to feedback from the emergency services community, OSHA has extended this public comment period to June 21, 2024.
St.Emlyn's - Emergency Medicine #FOAMed This was a really powerful session that took us on a journey from the past, to the present and left us with a feeling of hope for the future. I’ll […] The post R-A-C-E session at RCEM CPD conference. St Emlyn’s appeared first on St.Emlyn's.
This case came from a friend whose sister was the patient. She knew I was interested in ECGs, so she took a photo of this one. A young woman presented with acute chest pain. This was her presenting ECG: What do you think? This is clearly Brugada phenotype. There is downsloping ST Elevation in V1 and V2. To an experienced interpreter, it is clearly not due to OMI.
One of the biggest headaches in modern medicine is the apparent requirement to call busy specialists just to confirm what seems like an obvious treatment plan. In emergency medicine, this often happens when a patient needs to be admitted under one service, but with a medical problem related to another speciality. We get stuck in […] The post The Brain Injury Guidelines: Can we avoid talking to neurosurgeons?
What is the Life-Assist Difference? Life-Assist has been serving First Responders with emergency medical products and equipment since 1977. We Offer a Personal Touch in an Automated World Our genuine […] The post Emergency Medical Products for First Responders Since 1977 appeared first on American Ambulance Association.
St.Emlyn's - Emergency Medicine #FOAMed What you don’t do, determines what you can do Tim Ferris One of the most powerful personal lessons I have learned in recent years is every time I say YES […] The post Choosing with Intention. Liz Crowe appeared first on St.Emlyn's.
Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. The pain recurred at rest 90 minutes prior to presentation, felt like the patient’s prior MIs, and was not relieved by 6 sprays of nitro.
A razor is a rule of thumb that is helpful, although it isn't always correct. In medicine we're familiar with Occam's razor (the rule of parsimony). The cutoff razor states: if a continuous variable is dichotomized using a cutoff, then values near the cutoff provide little information. A simple illustration of the cutoff razor is […] EMCrit Project by Josh Farkas.
The Department of Homeland Security (DHS) Intelligence Enterprise Homeland Threat Assessment reflects the insights from across the Department, the Intelligence Community, and other critical homeland security stakeholders. It focuses on […] The post Homeland Security | Homeland Threat Assessment 2024 appeared first on American Ambulance Association.
By Brian Focht Practical tips for diversity, equity, and inclusion in your community April is Autism Awareness Month, but many people are aware of Autism every day. I became one of those for whom autism isn’t just a word but a reality when my son was diagnosed with autism spectrum disorder (ASD) in 2003. Our family is far from alone – in 2023, the CDC reported that approximately 1 in 36 children in the U.S. is diagnosed with ASD.
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